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Author
Topic: what meds to change (Read 2439 times)

hey guys,having been here for so long but suddenly something brings me again.I've been on sustiva/truvada for about 4yrs and half now i went to checkup every 3months , last result my cd4 decrease from 545 to 359 though am not worry about that cause i knew it can fluctuate .but what worries me was my kidney remain high all time about (1.4) for almost a year now even with much water before test.i asked my doc to change my regimen he said that i can change from truvada to (Ziagen abacavir)but I'm afraid of the side effect like (lipo,allergies etc)he told me that before changing I've to run a test called (HLA-B*5701)please do any of you know any meds that's better than Abacavir?thanks sanitex

I am guessing that the 1.4 is for serum creatinine. The normal range for this is 0.5-1.5 (mg/dL) for men and 0.6-1.2 for women.

Aside from the allergy, which you can be tested for, abacavir (Ziagen) generally has few side effects. It is usually combined with 3TC (lamivudine). The brand names for abacavir/3TC are Epzicom and Kivexa. There are many generic versions of this drug pair.

H! Newt, though I've not confirm to change the meds until I retest kidney again.but what pouched me to suspect kidney was I'm having itching on my hips now and my doc saw it last week visit .though normal range on kidney test here in Thailand is same as you mentioned.

Until now I was under the understanding that ABC has no generics. I'd be interested to get some references.At this time, generics are not allowed where I leave, but things may change...

Sanitex: While Epzicom (aka Kivexa) is less commonly used than Truvada due to a number of real (but screenable) hypersensitivity cases and may be less real suspicion of higher cardiac events (a highly debated issue, which FDA finally stopped by s statement that there is no such thing) it is usually well tolerated.A number of readers of this thread:http://forums.poz.com/index.php?topic=33062.0

have either publicly pr privately communicated that they did the switch due to kidney concerns and are content with the drug

Which is nice, because truvada and Kivexa appear to be the most favored NRTIs combos

As of today, and to my knowledge, not a single cohort manager has ever challenged this calculator. It may be wrong, but this is the only one available.

Not knowing your age and other factor that would enable me to calculate you FIB4 index, I have made simulations for several ages 30, 35, 40, 45 and 50 and I have assumes that your FIB4 associated risk is minimal, your hemoglobin level most favorable, race : other; hepatitis C : No.

H! Eric48,thanks for been kind and your devotion towards this topic i really enjoy it,though I'm not that educated but I follow your step.

Now I've register as a member to VACS already,but let me say this maybe it can help us I'm 38yrs black they are people who started with 20cd4 they still have life more than 20yrs now,even non hive's can die before us likewise us die before them,however anything can happen to anyone like by accident so do not focus your mind there it'll cause you more anxiety.

but Eric48 are you still on this combo because I want to change mine like (sustiva)is given me much anxiety , while I've been taking anxiety meds for almost 10yrs now(laxepro,tranxene)before diagnosed in 2007.I'd like to change both if possible after the(HLA-B*5701)test.

I've been having serious pain by the right waist side not the center waist I told my doc maybe neuropathic pain he said not it ,my dear am confuse.any way talk to you later

I am trying to make it a diversified source of information on this combo, you may find there some discussions of interest to you.

My doc once called it atypical, eventhough, it is an approved alternative in the US and a favored in Europe. Every med has its pros and cons as well as alarming side effects list of side effects. For Viramune and Abacavir the adverse events are very severe (and should not be taken lightly), but, of note, very rare too

Eventhough my Doc is to our country what Dr Gallant is to the US (an active educator, very experienced clinician and member of guidelines board), I suspect I may be the first one he initiates on both Viramune + Kivexa. Most people here are been started on Atripla. I think that was the result of:

- his experience with long term users who seem happy with it (and are of my age...)- my favorable basal low cardio risk- my very high sensitivity to psychoactive drugs- my high level of distress about the diagnosis (I was fainting at every lab, pharmacy or hospital visit...)

Today there is a very large choice, especially in the US, but not everywhere. Cost, ease of use, availability have also to be considered. V&K was not even on my list of options. At the time, and even today, newer, more expensive drugs are still reserved for second line regimen due to cost (in our socialized health care)

I had no idea Viramune could be an option for me (since my CD4 were in the 500) nor that it could be once daily.Note: there is no CD4 restrictions for treatment experienced people such as yourself.

Many times I have had second thoughts about Kivexa, and to some extend, I still have...

I think initiation to V&K might be more risky and should be limited to some patients profiles. It is metabolised 100% through the liver, therefore, you'd better have a good one.

Some people can simply not stand Viramune or Abacavir... But it seems to be a all or nothing thing. If you can not stand either one it can be horrendous, but if you can them, it is a breathe

On the other hand I think it is a very good switch-to option; most people who switch to V or K do this because they have problems with their current regimen. Typically kidney or bone problems they may have and might be attributed to Tenofovir or CNS effects that they usually blame on Efavirenz (sustiva). Kidney function issues are reversible, but not once eGFR goes too low...

For treatment experienced patients change from Truvada to Epzicom (aka Kivexa) seems to be easy enough. Apparently the other way around seems easy enough as well. Virologically they are very similar

I can not recall a thread from anyone successfull under Viramune (NVP) (i.e. who passed the tricky initial period successfully) switching to EFV (except for cost reasons and copays, which is a situation unique to the US)

You can easily switch back from Kivexa back to Truvada (in case Kivexa, especially its most feared compound ABC, is not suitable for you). The one exception would be a virologic failure, since they are virologically speaking very similar. Which is why I would be carefull about taking this medication off label, unless my doc and solid dual blinded trial say so. If taken in its original co-formulated form (with 3TC aka Lavimudine), it is authorized as once daily. (by the way, it is a rather large pill, I can not swallow it without a bit of water)

Same with Viramune and Sustiva. One interesting point here is that there is a dual blinded trial that shows that taking Viramune off label (that is once daily instead of the the recommended twice daily) is inferior for treatment naive (which you are not) but superior for treatment experienced (which you are). I take it off label 2 pills at the same time (like most my pill buddies)

Anxiety: I also suffer from anxiety issues. They may have multiple causes and meds may be not the most importantI am on the smallest dosed anxiolytic available here (one tiny pill in the afternoon) and 1/6 of a unisom (an OTC sleeping aid available in the US): the most difficult thing is to cut that tiny pill into 6 parts ;-)

If you are considering a switch (to V&K) I would recommend to go step by step and start with Epzicom (if you are eligible, once you HBLA test comes back) since the kidney concern might be the most immediate one. Then allow 6 months to get adjusted, then switch your NNRTI (S to V), if you want.

Timing: Atripla is known to be less demanding on timing. Epzicom also but may be not to the same extend.Off label (2 pills once daily) of standard Viramune: certainly not. I take mines right on top of the designated hour. Extended release Viramune XR should be nicer in that respect

If you are a smoker, this makes your basal cardio risk higher and this is not good when considering Abacavir. smoking cessation highly recommended if Abacavir is the only option the docs are putting on the table.

In socialized care, options are limited. There are other combos that I might have preferred if given the choice.Yet, within these constraints, knowing more about this combo today and reading a bit about other combos, I would happily make the exact same choice as I did 2 years ago.

The VA has a lot of experience this all the above medication and you will certainly find good advise there.

another good combination is truvada and viramune. they don't have the psycho active side effects of sustiva and are available both as a brand and as a generic in Bangkok. for viramune there is an initial minimal risk of severe intolerance that has to be monitored. since i didn't have the intolerance i have been using it with great effect for years.

joe, thank you for been kind and supportive whenever I brought a topic to the forum,also Eric48 your wonderful information's,time has made a difference to me and more courageous ever before .I'll think then let the doc to finalize the best way maybe, truvada to Abacavir first or sustiva first to viramune do to CNS side effect .Eric48,pls I'd like to know what other side effects does you had from this combo i mean like adding weight most concern big belly.

I think I went through the entire list pf side effects... Constipation, heart beat, hypertension, anxiety weight gain, cholesterol, head ackes, etc, etc.

One by one, one after the other,, and always in such a minor sub clinical level that I should not complain. After a while things get back into order. I have put on a bit of weight, but BMI is still within range.

IMHO, my 'older' age makes it a bit more complicated to get adjusted. I've given myself 3 years. I am 2 years into treatment and occasionnal head ackes (and need for the smallest possible sleeping aid, yesterday I even forgot to take it, no problemo) may be the only thing I would report to my doc.

All the mild side effects have kind of come and go.

I have not missed a day of work.

The only side effect I did not have is that I was expecting my hair to grow back.Unlucky here. Things have stayed the same...

Honnest I take the pills just like it is a aspirin or multivitamin.

My multi pharmacy for onstipation head acke, etc has significantly decreased and I threw away a lot of unused last week.

I guess adjustment time may vary from person to person. I would not worry about that.

There has been a bit of trial and error about best time to take the meds. Many people report they cannot stand it in the morning and take at nights. Me it is is the other way around. I pop up the pills all at one time early in hte morning and nothing to worry about forgetting,

The adverse side effects (that would require a combo change) are very rare,but, since they may look similar for Viramune or Abacavir, It would be difficult to sort things out;

I would go for a step by step meds change.

Long timer users of this combo seem happy on hte long run, which is may be one reason this once demoted combo is coming back to fashionable